$315.45
99496 requires both high-complexity decision making and a visit within seven days. 99495 covers moderate-complexity decision making with a visit within 14 days, or high-complexity decision making when the visit occurs on days 8 through 14.
On this page
CMS RVU26D · Effective 2026-10-01
99495 Transitional care management Medicare reimbursement rates in Connecticut
Report transitional care management after a qualifying discharge when timely contact, at least moderate-complexity decision making, and a visit within 14 days are documented. Compare 99495 office and facility rates across CMS payment localities in Connecticut.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 99495 in Connecticut?
Connecticut has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$232.61
1 of 1 localities have a supported rate.
Payment area: Connecticut
One mapped payment locality.
Facility setting
$127.21
1 of 1 localities have a supported rate.
Payment area: Connecticut
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Care management
About 99495: Moderate-complexity transitional care management
Report transitional care management after a qualifying discharge when timely contact, at least moderate-complexity decision making, and a visit within 14 days are documented.
This service covers a practitioner's management of a patient returning to a community setting after an inpatient hospital stay, observation, skilled nursing facility stay, inpatient rehabilitation, or partial hospitalization. The 30-day period begins on the discharge date. The practice must make interactive contact with the patient or caregiver within two business days. A face-to-face visit must occur within 14 calendar days; medication reconciliation must occur by that visit. Other work may include reviewing discharge records, following up on pending tests, arranging referrals, and educating the family. Primary care physicians, NPs, and PAs commonly report the service, with clinical staff helping with outreach.
Select 99495 when medical decision making is at least moderate and the visit occurs within 14 calendar days; high-complexity decision making with a visit within seven days instead meets the timing and complexity criteria for 99496. Document the discharge date, timely contact or contact attempts, visit date, medication reconciliation, and decision making. Only one practitioner reports transitional care management for a patient's 30-day period, once per period. The required face-to-face visit is included rather than billed as a separate E/M visit.
Where the value comes from
- Work RVU2.78 · 42%
- Practice expense (office) RVU3.62 · 55%
- Malpractice RVU0.19 · 3%
723.7K
Medicare services in 2024 · #182 by national volume
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
99495 compared with similar codes
Office rates for Connecticut, from the same CMS release.
$143.02
A post-discharge office visit may be reported with 99214 when transitional care requirements are unmet and the visit supports that E/M level. 99495 requires timely contact, at least moderate-complexity decision making, and a visit within 14 days.
No office rate
99238 covers discharge day management in the facility. 99495 covers transitional care after discharge, and its required face-to-face visit cannot occur on the discharge service date.
$69.63
99490 is monthly clinical staff time for ongoing chronic care management. 99495 is discharge-triggered transitional care tied to a contact deadline and a face-to-face visit deadline.
Compare 99495 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Connecticut →
Office / nonfacility
$232.61
Facility
$127.21
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 99495 in Connecticut.
PPRRVU2026_Oct_nonQPP.csv
13,159
- Code
- 99495
- Physician work
- 2.78
- Practice expense
- 3.62
- Malpractice
- 0.19
GPCI2026.csv
38
- Locality
- Connecticut
- Physician work
- 1.020
- Practice expense
- 1.077
- Malpractice
- 1.210
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.78 | × 1.020 | 2.8356 |
| Practice expense | 3.62 | × 1.077 | 3.8987 |
| Malpractice | 0.19 | × 1.210 | 0.2299 |
| Total RVUs | 6.9642 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Connecticut$232.61
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.78 | 1.02 |
| Practice expense | 3.62 | 1.077 |
| Malpractice | 0.19 | 1.21 |
(2.78 × 1.02 + 3.62 × 1.077 + 0.19 × 1.21) × $33.4009 = $232.61
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.78 | 1.02 |
| Practice expense | 0.69 | 1.077 |
| Malpractice | 0.19 | 1.21 |
(2.78 × 1.02 + 0.69 × 1.077 + 0.19 × 1.21) × $33.4009 = $127.21
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
99495 billing questions
How do I choose between 99495 and 99496?
99496 requires high-complexity decision making and a face-to-face visit within seven calendar days of discharge. Report 99495 for moderate-complexity decision making with a visit within 14 days, or high-complexity decision making with a visit on days 8 through 14.
Can I bill the face-to-face visit separately as an office visit?
No. The required face-to-face visit is included in 99495. Additional medically necessary E/M visits later in the 30-day period may be reported separately.
What if the two-business-day contact was not successful?
CMS accepts two or more separately documented, unsuccessful contact attempts within the two business days. Continue trying to reach the patient or caregiver; if the remaining requirements are met, the service may still be reported.
What date of service should go on the claim, and when can it be submitted?
Use the date of the face-to-face visit as the date of service. CMS allows submission once that visit has been furnished, without waiting for the 30-day period to end.
Can the face-to-face visit be done by telehealth?
Yes. The required visit can be furnished by telehealth when Medicare telehealth billing requirements are met.
Can the discharging physician also bill 99495?
Yes. A physician who reports discharge day management may also report transitional care management, but the required face-to-face visit cannot occur on the discharge service date.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
13,15699492,,1st psyc collab care mgmt,A,,1.88,2.78,,0.44,,0.14,4.80,2.46,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,15799493,,Sbsq psyc collab care mgmt,A,,2.05,2.15,,0.49,,0.14,4.34,2.68,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,15899494,,1st/sbsq psyc collab care,A,,0.82,0.96,,0.20,,0.06,1.84,1.08,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,15999495,,Transj care mgmt mod f2f 14d,A,,2.78,3.62,,0.69,,0.19,6.59,3.66,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,16099496,,Transj care mgmt high f2f 7d,A,,3.79,4.91,,0.95,,0.24,8.94,4.98,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,16199497,,Advncd care plan 30 min,A,,1.50,1.01,,0.38,,0.09,2.60,1.97,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,16299498,,Advncd care plan addl 30 min,A,,1.40,0.85,,0.41,,0.09,2.34,1.90,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808